Insurance coverage for Minimal Residual Disease (MRD) testing can vary based on the type of test, the patient's insurance plan, and the medical necessity determined by the healthcare provider.

When MRD Testing Is Typically Covered

• FDA-Approved tests: MRD tests like clonoSEQ® (Next-Generation Sequencing) are FDA-approved and more likely to be covered by insurance.
• Medically necessary: If a doctor recommends MRD testing as part of standard care to monitor treatment response or guide therapy decisions, many insurers may cover it.
• Medicare/Medicaid: Medicare covers FDA-approved MRD testing for multiple myeloma patients under certain conditions. Medicaid coverage varies by state.

When MRD Testing Might Not Be Covered

• Experimental or non-standard tests: Newer or experimental MRD tests, like some blood-based liquid biopsies, may not be covered until more clinical validation is available.
• Out-of-Network labs: If the testing is done at a lab not in the insurance network, patients may face higher out-of-pocket costs.
• Lack of prior authorization: Some insurers require prior authorization before covering MRD tests.

What Myeloma Patients Can Do

• Check coverage: Contact your insurance provider to confirm if MRD testing is covered under your plan.
• Ask your doctor: Your healthcare team can provide documentation to support why MRD testing is medically necessary.
• Financial Assistance: Companies like Adaptive Biotechnologies (maker of clonoSEQ®) may offer financial assistance programs for eligible patients. Always check the product-branded page for more information on their support programs. 
  • Adaptive Assist Patient Support Program (EN)
  • Adaptive Assist Programa de apoyo al paciente (ES)

Helpful Tip:

Always ask about potential costs before testing to avoid unexpected bills and explore financial aid options if needed. Continue reading here.